Efficacy of aripiprazole long-acting injection monotherapy in pregnancy-related hypomania: A treatment choice through shared decision-making.

Background: Managing bipolar disorder during pregnancy requires balancing maternal mental health and fetal safety. While guidelines often focus on severe mania, the management of hypomania, a common clinical challenge, remains poorly defined. Although shared decision-making (SDM) is recommended for treatment planning, its application in managing acute mood episodes during pregnancy remains underexplored, especially without robust evidence. Case Presentation: A woman in her thirties with DSM-5 Bipolar I Disorder developed a hypomanic episode at 32 weeks of gestation while on aripiprazole once-monthly (AOM) 400 mg monotherapy. Although antipsychotic augmentation was considered, limited evidence and strong patient and family concerns regarding fetal exposure led to an SDM-based approach. The AOM monotherapy was continued with intensive monitoring. Hypomanic symptoms resolved within 4 weeks (Young Mania Rating Scale scores decreased from 14 to 1), with corresponding improvements in functional scores (Global Assessment of Functioning and the Social and Occupational Functioning Assessment Scale), and the patient delivered a healthy infant at term. She remained euthymic at 7 months postpartum. Conclusion: SDM, when combined with intensive measurement-based care, may effectively manage acute hypomanic episodes during pregnancy. This case demonstrates that a conservative approach, guided by SDM, can be a viable strategy for managing pregnancy-related hypomania, highlighting the importance of an individualized treatment plan that respects patient values in a clinical setting with limited evidence.